The Science Journal of the American Association for Respiratory Care

2002 OPEN FORUM Abstracts

The Effects of Inservice Education and Annual Performance Reviews on the Complications of Nasal CPAP in the Neonate

Kathleen Deakins RRT, Steven Clark RRT, and Timothy Myers BS RRT.
Rainbow Babies & Children?s Hospital, Cleveland, Ohio

Introduction: Nasal CPAP (NCPAP) is used to reduce airway resistance and work of breathing, and improve oxygenation and compliance through alveolar stabilization in the treatment of newborn Respiratory Distress Syndrome. Along with these physiologic benefits of CPAP is the potential for complication development caused by improper application and maintenance of the CPAP device. The purpose of this observational study is to determine if annual staff inservice education and training affects the number of CPAP complications in our neonatal population.

Methods: In a prior observational study conducted November 2000 to May 2001, we documented the incidence of complications incurred during NCPAP delivery at 34%. When utilizing fluidic NCPAP, we documented a complication rate of 41%. With conventional NCPAP, 15% of our patients developed a complication. Nurses and respiratory therapists share the responsibility of maintaining nasal CPAP in the NICU. Annual performance reviews for NICU nurses (~150) included completion of a self learning packet including a review article on CPAP, review of indications, complications, ways to prevent nasal septal breakdown, and causes of weaning failures from CPAP. A post-test was given at the completion of the review. In May 2001, a Clinical Specialist from Hamilton Medical provided inservice education and training to nurses and respiratory therapists. At the conclusion of the review period, the observational study was repeated. From May 31, 2001 to January 2, 2002, 100 patients received NCPAP in our NICU. The Infant Star ventilator provided conventional NCPAP. NCPAP prongs (Medicomp Inc. Princeton MN) were secured by twill tape attached to an Arabella NCPAP cap. Fluidic NCPAP was delivered by the Arabella NCPAP system (Hamilton Medical, Reno NV). An Arabella NCPAP cap secured fluidic NCPAP prongs and generators. We assessed patients on a daily basis for complications caused by NCPAP. Complications assessed included bleeding, flaring of the nares, nasal septal breakdown, orbital edema and excoriation of the nares.

Results: In this follow-up study, 22% of all patients placed on NCPAP developed at least one complication. Eight percent of patients on conventional and 31% of patients on fluidic NCPAP developed complications. The table compares complication rates before and after annual reviews and inservices:

Total # patients Weight/Gest.Age Year Incidence of Complications % change
111 30wk/1325g 2001 34%
100 30wk/1471g 2002 22%
Conventional CPAP
  30wk/1489g 2001 15%
  30wk/1636g 2002 8%
Fluidic CPAP
  29wk/1159g 2001 41%
  29wk/1307g 2002 31%

Conclusion: Overall, we realized a 35% reduction in our NCPAP complication rate. A greater reduction occurred in conventional NCPAP compared to fluidic NCPAP. Annual performance reviews with education and training contributed to a reduction in the incidence of NCPAP complications in our NICU.


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